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Typical inquiry: When to start the meds?

May 30, 2006

First of all, a huge thanks for this service. I think all the readers appreciate your taking time to address our questions and worries. Your warm, helpful advice ameliorates much concern. My question is typical, though I couldn't find a previous post that exactly fits my situation, so please bear with me. I am a 54 male, basically in good health, infected early January this year (in Japan, where I live). Primary infection symptoms were very uncomfortable but did not require hospitalization and went away after two weeks. Although I was offered the option of beginning the medications right away, I decided not to, as to give my body the opportunity to pull out of the primary infection slump on its own. Each month since then, the doctor has kept track of my numbers, which are as follows: Jan. CD4 188 (36.2%) VL 2.7 million, Feb. CD4 415 (27.0%) VL 94,000, Mar. CD4 590 (23.4%) VL 76,000, May. CD4 469 (24.1%) VL 20,000. My questions are, why does the CD4% seem to go down with an increased number of CD4 cells, how low may the viral load become before attaining the set point, and, based on your clinical experience of similar situations, how long might I be able to remain stable before beginning the medications? Thank you very much for your time an expertise on this problem.

Response from Dr. Wohl

What you have experienced is fairly typical. Soon after infection, teh viral load skyrockets, in your case to over 2 million per cc of blood. The viral load then starts to fall and will reach a plateau over a period of 6 months or so. I suspect you are close to your set point now. The viral load test has some degree of variability such that there can be as much as a 3 fold difference in the level measured when the SAME blood is tested repeatedly. So, your 20,000 viral load could be tested again and produce a result of 60,000.

The CD4 cell count has recovered from an initial decline. The CD4% depends not only on the CD4 cells but also the larger population of white blood cells. It also looks like both these numbers have stablized although sometimes it can take a few more months before the CD4 cells rise back up after initial infection.

If your viral load is around 20,000 or so and your CD4 count 500, statistics would suggest you would not have a decline in your CD4 cells to the magic number of 350 (where currently HIV therapy is advised) for more than a year or two. These are statistics and can not tell what will happen to you exactly.

I hope that helps.


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